MDoffice handles capitated HMO and PPO plans with a minimum of clerical effort and maintains eligibility and copayments by plan and patient. In addition to providing alerts before authorized money and/or visits are exhausted, it also tracks capitation payments by member count with distribution across multiple providers.

When entering charges for capitated plans, MDoffice allows you to post procedures for services rendered and automatically record a zero charge for patients covered by capitated plan. By posting capitation charges without adding them to receivables, MDoffice tracks the value of capitated services without inflating your A/R. This approach of automatic creation and writeoffs of capitated charges allows for your receivables to be much more accurate.

Capitation payment management.
You can also produce reports of all eligible capitated patients to show how many patients you have for each capitated plan. By dividing the number of patients in a particular plan by the total patients in your practice, you can get a percentage of the practice that is capitated and easily track capitation by provider and facility.

Simplified capitation record keeping.
By having every fee entered at the contracted amount and letting MDoffice automatically writeoff the difference between the copay and contracted fee, you're able to compare what was written off against what has been actually paid in capitation and incentive payments. MDoffice easily allows for automatic capitation adjustments on normal fees for subsequent analysis versus capitation.

Fast visit encounter entry.
Each time a patient using a capitated plan visits your office, the steps for a capitated visit are identical to the steps for a normal patients visit. Managed care claims are entered in the same way as any other claim, however, if there is a visit copayment required with the insurance plan, the amount of the copayment comes directly from the patient's primary insurance plan.

Automatic copayment due.
For example, if the office charges a total of $60.00 with a $10.00 copayment, create the claim with a $60.00 charge for procedures, then enter a $10.00 patient copayment (if they actually paid). MDoffice automatically adjusts off $50.00. As a result of this writeoff, MDoffice will automatically mark the claim as being "Paid" unless there was no visit payment in which case the status of the $10.00 will be "Bill to Patient."

Capitation payments.
Capitation payments can be tracked by member count and distributed across multiple physicians. Each payment can also be posted using membership or age/sex. MDoffice also provides complete analysis of capitation versus other methods of payment by reconciling capitation payments received by comparing the capitation received against the capitation expected to verify that the correct payment has been received from the payor.

Membership rosters.
MDoffice maintains an up-to-date list of each plan’s members. For each member MDoffice tracks the membership ID number, start date, and termination date, as well as any comments. This is a master roster of all managed members containing historical eligibility detail. The Capitation Distribution Report lists each member, their eligibility and the associated capitation information, broken down by plan and grouped by PCP. The report also shows member counts, including deletions.

How are you doing on capitated contracts?
MDoffice's capitated reports show actual services for charges for capitated patients and what you would have received on a fee for service basis to help you monitor your success on these contracts. Managed care reports allow you to quickly compare the capitated payments received against standard charges and other methods of payment, comparing the capitated payment received to standard charges. Other reports show patients whose authorizations need to be renewed for additional services.

Referral Management
Contract Management

Intelligent capitated billing.